Basic Information
| Provider Information | |||||||||
| NPI: | 1457326407 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VENTRESCA | ||||||||
| FirstName: | KIMMERI | ||||||||
| MiddleName: | |||||||||
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| Credential: | LISW S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 611 W MARKET ST | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443031406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309964600 | ||||||||
| FaxNumber: | 3305649296 | ||||||||
| Practice Location | |||||||||
| Address1: | 611 W MARKET ST | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443031406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309964600 | ||||||||
| FaxNumber: | 3305649296 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2006 | ||||||||
| LastUpdateDate: | 09/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | S0030755 | OH | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | I0700207 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.